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href=\u0022https:\/\/www.bmj.com\/sites\/default\/files\/advagg_css\/css__-BkZ71IF4pBXmZfP4vYyswWdIhuaKktrUUQ4i2vtUVo__0i_0YcYkMECNn0z7FdhNoJ8gLWleqnTtjnHRAmLijvc__chojsVFQ_KNmMYwqAo1PXEDmPgPIeOXMB_oVYPBv18M.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-bmj-related-rapid-responses\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-views-panes pane-bmj-rapid-responses-bmj-rr-article\u0022 \u003E\n \n \u003Ch2 class=\u0022pane-title\u0022\u003EAll rapid responses\u003C\/h2\u003E\n \n \n \u003Cdiv class=\u0022pane-content\u0022\u003E\n \u003Cdiv class=\u0022view view-bmj-rapid-responses view-id-bmj_rapid_responses view-display-id-bmj_rr_article view-dom-id-8433753d0db11ca47ce12b2a67023ed0\u0022\u003E\n \u003Cdiv class=\u0022view-header\u0022\u003E\n \u003Cdiv id=\u0022response-header-description\u0022\u003ERapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers\u0027 letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.\u003C\/div\u003E \u003C\/div\u003E\n \n \u003Cdiv class=\u0022view-filters\u0022\u003E\n \u003Cform action=\u0022\/\u0022 method=\u0022get\u0022 id=\u0022views-exposed-form-bmj-rapid-responses-bmj-rr-article\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cdiv\u003E\u003Cdiv class=\u0022views-exposed-form\u0022\u003E\n \u003Cdiv class=\u0022views-exposed-widgets clearfix\u0022\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-sort-by\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-sort-by form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-sort-by\u0022\u003ESort by \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-sort-by\u0022 name=\u0022sort_by\u0022\u003E\u003Coption value=\u0022field_highwire_a_epubdate_value\u0022 selected=\u0022selected\u0022\u003EDate Published\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-sort-order\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-sort-order form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-sort-order\u0022\u003EOrder \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-sort-order\u0022 name=\u0022sort_order\u0022\u003E\u003Coption value=\u0022ASC\u0022\u003EAscending\u003C\/option\u003E\u003Coption value=\u0022DESC\u0022 selected=\u0022selected\u0022\u003EDescending\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-per-page\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-items-per-page form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-items-per-page\u0022\u003EItems per page \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-items-per-page\u0022 name=\u0022items_per_page\u0022\u003E\u003Coption value=\u00225\u0022\u003E5\u003C\/option\u003E\u003Coption value=\u002210\u0022 selected=\u0022selected\u0022\u003E10\u003C\/option\u003E\u003Coption value=\u002220\u0022\u003E20\u003C\/option\u003E\u003Coption value=\u002240\u0022\u003E40\u003C\/option\u003E\u003Coption value=\u002260\u0022\u003E60\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-submit-button\u0022\u003E\n \u003Cinput class=\u0022btn btn-info form-submit\u0022 type=\u0022submit\u0022 id=\u0022edit-submit-bmj-rapid-responses\u0022 name=\u0022\u0022 value=\u0022Apply\u0022 \/\u003E \u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003C\/form\u003E \u003C\/div\u003E\n \n \n \u003Cdiv class=\u0022view-content\u0022\u003E\n \u003Cdiv class=\u0022views-row views-row-1 views-row-odd views-row-first\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment node-promoted clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/content\/358\/bmj.j3839\/rr-0\u0022\u003E\u003Ch3\u003EI find the NHS lack of faith disturbing\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cp\u003EIt is a sign of insecurity when the NHS wants to use an army-style conscription policy to retain medical graduates.\u003C1\u003E It shows the NHS lacks faith in competing with medical employers overseas. In fairness, many of my British colleagues have unrealistic expectations of their career prospects overseas. I have worked in both the British and North America healthcare systems, and would like to debunk some myths here. The followings are some comments I heard from my British colleagues:\u003C\/p\u003E\n\u003Cp\u003E\u0022I will have a better work-life balance overseas.\u0022 In Toronto, Canada, for example, medical residents (equivalent to junior doctors in the UK) can have up to seven 24-hour in-hospital on-call shifts every 28 days.\u003C2\u003E They can be on call every second weekend.\u003C\/p\u003E\n\u003Cp\u003E\u0022I will have a better pay overseas.\u0022 Foundation year 2 doctors in the UK are paid about \u00a346\/hour for a locum on-call shift,\u003C3\u003E whereas medical residents in Toronto are paid a standard stipend of $116\/day for a 24-hour on-call shift, equivalent to less than \u00a33\/hour.\u003C2\u003E\u003C\/p\u003E\n\u003Cp\u003E\u201cI will have a better opportunity to be selected in a posh speciality overseas.\u201d In 2017, the general practice residency program in British Columbia had 52 positions for 1045 international applicants.\u003C4\u003E There is no trust grade or senior associate specialist posts in North America - you are either a resident or fully qualified attending. Alternatively, you can be a jobless doctor.\u003C\/p\u003E\n\u003Cp\u003E\u201cMy British medical degree will be highly valued overseas.\u201d Indeed, I have heard many North American doctors calling the international medical training very \u201chands-off.\u201d Ironically, most of the people that make this comment never work in the UK. Ironically, North American doctors do not need to perform many ward procedures, such as venipuncture, intravenous cannulation, nasogastric tube insertion, and writing drug charts, because they are duties of nurses and ward clerks there. People apparently think the NHS pays junior doctors to just go to lectures and study in libraries. At times, our British work ethics are called into questions. I was asked whether I can manage heavy workload, in view of the recent junior doctor strike in England.\u003C\/p\u003E\n\u003Cp\u003EDespite these, in my humble opinion, the North Americans are superior in their quality of medical training. For instance, a first-year resident takes referrals, consults new patients, and reviews his assessment and management plans with his senior. In return, his senior educates the junior on the spot, provides timely feedback on the consultations, and then finalizes the junior\u0027s management plans. This is very different from the NHS in which a FY1 doctor could be mainly used as a clerking machine, cannula technician, and discharge typewriter.\u003C5\u003E A FY1\u0027s differential diagnoses of the condition is rarely appreciated, and could be misinterpreted as \u201carrogantly calling the shots\u201d in front of the seniors. In North America, doctors may be offered an educational grant for delivering formal teaching, which is an attractive incentive to strive for excellence in education. In contrast, British doctors may be given simply a certificate of appreciation for delivering formal teaching. An NHS institution could struggle to find lecturers to fill the teaching schedule.\u003C6\u003E\u003C\/p\u003E\n\u003Cp\u003EThe North Americans emphasize on patient safety. For instance, British junior doctors may often struggle to find anyone to help with blood taking, even in acute situations - this rarely happens in North America. The health professionals there are very skilled and keen to expand their scope of practice. When managing referrals, the North American non-admitting team can only suggest orders, but not starting or changing orders for patients. This way, the admitting team decides what is suitable. This setup also prevents the admitting team from dumping administrative work, such as preparation of discharge summaries, to another team.\u003C\/p\u003E\n\u003Cp\u003EI understand that the NHS wants reassurance in their investment in medical training, and it is heartbreaking to see their training products departing from the UK. With limited funding, it is tough for the NHS to financially compete with employers overseas. Nevertheless, the NHS can make the work environment more favourable and improve the morale and job satisfaction of its employees. Coercing employees to stay would only further lower the morale at work, and make employees flee as soon as their conscription contracts expire. Many British trained consultants I met stay in the NHS because of family reasons. If every employee were respected as a valuable family member of the NHS, would the employees still be eager to leave?\u003C\/p\u003E\n\u003Cp\u003EReferences\u003C\/p\u003E\n\u003Cp\u003E1. Rimmer A. Plan for army-style conscription of doctors is reconsidered. BMJ. 2017;358:j3839.\u003Cbr \/\u003E\n2. Call stipends FAQs. Toronto, Canada: University of Toronto; 2016; cited [Nov 17, 2017]. Available from: \u003Ca href=\u0022http:\/\/pg.postmd.utoronto.ca\/current-trainees\/while-youre-training\/access-call-stipend-resources\/call-stipends-faqs\u0022\u003Ehttp:\/\/pg.postmd.utoronto.ca\/current-trainees\/while-youre-training\/acces...\u003C\/a\u003E.\u003Cbr \/\u003E\n3. Rimmer A. Locum pay rates have risen despite hourly rate cap. BMJ. 2017;356:j135.\u003Cbr \/\u003E\n4. UBC IMG statistics. Vancouver, Canada: University of British Columbia; 2017; cited [Nov 17, 2017]. Available from: \u003Ca href=\u0022http:\/\/carms.familymed.ubc.ca\/img-applicants\/img-statistics\/\u0022\u003Ehttp:\/\/carms.familymed.ubc.ca\/img-applicants\/img-statistics\/\u003C\/a\u003E.\u003Cbr \/\u003E\n5. Yeung EYH. How are junior doctors supposed to learn without the opportunity? BMJ. 2017;359:j5057.\u003Cbr \/\u003E\n6. Junior doctors don\u2019t get enough teaching. BMJ. 2011;342:d2246. \u003C\/p\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E20 November 2017\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Eugene Y.H. Yeung \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Doctor \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n Royal Lancaster Infirmary \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Ashton Road, Lancaster, LA1 4RP, UK \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-row views-row-2 views-row-even views-row-last\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment node-promoted clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/content\/358\/bmj.j3839\/rr\u0022\u003E\u003Ch3\u003ERe: Plan for army-style conscription of doctors is reconsidered\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cp\u003ECan I ask this simple question?\u003Cbr \/\u003E\nWill UK graduates qualifying as Vets and Dentists, the majority of who will go into private practice, though possibly not abroad, receive the same attention and \u0022conscription\u0022 as that being considered for our Uk Medical Graduates? And why stop there? What about Accountants or Lawyers?\u003Cbr \/\u003E\nDil Sen\u003C\/p\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E11 August 2017\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Dil Sen \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Clin Senior lecturer \u0026amp;Hon.Consultant in Occupational Medicine \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n Univ of Manchester \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Centre for Occupational \u0026amp; Environmental Health, Univ of manchester \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003C\/div\u003E\n \n \n \n \n \n \n\u003C\/div\u003E \u003C\/div\u003E\n\n \n \u003C\/div\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003C\/body\u003E\u003C\/html\u003E"}